The Lymphedema Advocacy Group (LAG) and the Lymphedema Education & Awareness Project (LEAP) put out a patient handout, Insurance Coverage for Lymphedema Compression Garments and Supplies. It answers the questions we hear most after someone gets their first garments: when can I get more, what will I pay, and what if I'm denied? Here is what it says, in plain language. For the basics of the law, see our article The Lymphedema Treatment Act: What Medicare Covers and How to Qualify.
What your doctor needs to send
A lymphedema diagnosis (codes Q82.0, I89.0, I97.2 or I97.89)
A prescription for each item
Office notes that list the stage of your lymphedema, and, for custom garments, why a ready-to-wear garment won't work for you
We can help your doctor or therapist get the paperwork right. Just ask.
How many garments Medicare covers
Daytime garments: 3 per affected body part every 6 months
Nighttime garments: 2 per affected body part every 2 years
Bandaging supplies: no set limit
Accessories (liners, padding, zippers, donning and doffing aids): no set limit, based on your needs
When can I reorder?
Once 6 months have passed since the delivery date of your first daytime set, you can reorder 1, 2 or all 3 garments. Sets you didn't order don't roll over to the next 6 months, so if you only got 1 garment last time, you can't get 5 next time. If you're unsure when you're due, call us and we'll check your dates.
What will I pay?
Original Medicare: garments fall under Part B, so the yearly Part B deductible and 20% coinsurance apply. A supplemental (Medigap) or secondary plan usually covers the 20%.
Medicare Advantage and other plans: costs depend on your plan, usually the same copays and deductibles as other medical equipment (DMEPOS).
Choosing a supplier matters
Use an in-network supplier. Medicare suppliers come in two kinds. Suppliers who accept assignment can only charge the Medicare-approved amount. Non-participating suppliers may charge more and pass the difference on to you. Ask before you order. Midwest Compression works with Medicare and most major insurance plans; call us and we will check your coverage before you order.
What if I'm denied?
LAG recommends appealing every denial. Many patients win, and each appeal on record helps shape future policy. Follow your plan's appeal steps, and get help:
Employer insurance (especially self-funded plans): talk to your HR department.
Private or state-based plans: contact your state insurance department to file a complaint and ask for help.
Original Medicare or Medicare Advantage: call your U.S. Representative's or Senator's office. They have caseworkers who help constituents.
The Lymphedema Advocacy Group has more help
The Lymphedema Advocacy Group led the fight to pass the Lymphedema Treatment Act and keeps free resources for patients: coverage guides, a supplier directory, and a Take Action page with steps for denials and appeals. Visit LymphedemaAdvocacyGroup.org and LymphedemaProject.org. Medicare's official page on the new coverage is at go.cms.gov/48PxTKf.
Questions about your coverage or reorder dates? Call (800) 883-1549 or text (517) 657-5223.
Source: "Patient Information: Insurance Coverage for Lymphedema Compression Garments and Supplies," Lymphedema Advocacy Group and Lymphedema Education & Awareness Project. This is general information, not legal or billing advice.
